Individual
MARY LOU HERBST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
555 CONNOR CT, LAKE MILLS, WI 53551-1665
(920) 342-7748
Mailing address
555 CONNOR CT, LAKE MILLS, WI 53551-1665
(920) 342-7748
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
315524-31
WI
Other
Enumeration date
02/02/2013
Last updated
02/02/2013
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